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PURPOSE: Patients with clear cell renal cell carcinoma (ccRCC) might develop metastasis after surgery with curative intent. We aimed to characterize the expression levels of microRNAs in the urine (UmiRNAs) of patients before and after nephrectomy to determine the impact of UmiRNAs expression in the emergence of metastases. METHODS: We prospectively collected pre- and post-nephrectomy urine samples from 117 patients with clinically localized and locally advanced ccRCC. UmiRNAs were extracted, purified, and measured using RT-PCR. Relative quantifications (RQ) of 137 UmiRNAs were calculated through 2-∆∆ method. The post-surgery/pre-surgery RQs ratio represented the magnitude of the expression levels of the UmiRNAs. The association of UmiRNA expression and the development of distant metastases was tested with Cox regression model. RESULTS: Five UmiRNAs (miR-191-5p, miR-324-3p, miR-186-5p, miR-93-5p, miR-30b-5p) levels were upregulated before nephrectomy (p < .05). This conferred a 2- to 4-fold increased risk of metastasis, with miR-191-5p showing the most significant association with this endpoint (HR = 4.16, 95% CI = 1.38-12.58, p = .011). In a multivariate model stratified with stage and Fuhrman grade, we found that miR-191-5p, miR-324-3p, and miR-186-5p exhibited a strong association with metastasis development in patients with pathological T3 (pT3) tumors. Enrichment analysis with the most differentially expressed UmiRNAs showed that these UmiRNAs targeted genes that regulate cell survival and proliferation. CONCLUSION: Our study indicated UmiR-191-5p, UmiR-324-3p, and UmiR-186-5p are potential markers to predict the development of metastasis, particularly in pT3 patients. PATIENT SUMMARY: We compared changes of UmiRNAs expression detected pre- and postnephrectomy of patients with ccRCC. Our findings suggest that UmiRNA expression likely reflects tumor-specific changes that can be promising to predict the metastasis development, particularly in patients with non-metastatic locally advanced ccRCC. If confirmed, these findings may be useful for surveillance protocols for adjuvant therapy protocols.

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We correlated contrast-enhanced cross-sectional imaging and outcomes to assess the reproducibility of ultrasonographic criteria for renal minimally complex (MC) cysts. From 2003 to 2015, 143 cysts were described as complex or MC by ultrasound (US). After exclusions, 98 US studies were retrospectively evaluated and compared with computed tomography (CT)/magnetic resonance imaging (MRI). At sonography, 51 were MC cysts and 47 were complexes according to two independent observers. Inter-observer agreement for US was 0.704 and 0.745 for CT/MRI. Of 51 cysts classified as MC by US, 38 were Bosniak I/II and 6 were Bosniak IIF by CT/MRI. In 7, there were no cross-sectional images; however, they were stable for at least 2 y. Of 47 complex cysts, 9 were Bosniak II, 22 Bosniak IIF, 8 Bosniak III and 8 Bosniak IV. No Bosniak III/IV cysts by CT/MRI were classified as MC by US. Our results indicate that US offers reproducible criteria for MC cysts and may be used alone for these lesions.

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OBJECTIVE: Prostate cancer is the most common nonskin cancer and second most common cause of cancer mortality in older men in the United States (USA) and Western Europe. Androgen-deprivation therapy alone (ADT) remains the first line of treatment in most cases, for metastatic disease. We performed a systematic review and meta-analysis of all randomized controlled trials (RCT) that compared the efficacy and adverse events profile of a chemohormonal therapy (ADT ± docetaxel) for metastatic hormone-naive prostate cancer (mHNPC). METHODS: Several databases were searched, including MEDLINE, EMBASE, LILACS, and CENTRAL. The primary endpoint was overall survival. Data extracted from the studies were combined by using the hazard ratio (HR) or risk ratio (RR) with their corresponding 95% confidence intervals (95% CI). RESULTS: The final analysis included 3 trials comprising 2,264 patients (mHNPC). Patients who received the chemohormonal therapy had a longer clinical progression-free survival interval (HR = 0.64; 95% CI: 0.55 to 0.75; p<0.00001), and no heterogeneity (Chi2 = 0.64; df = 1 [p = 0.42]; I2 = 0%). The biochemical progression-free survival (bPFS) also was higher in patients treated with ADT plus docetaxel (HR = 0.63; 95% CI: 0.57 to 0.69; p<0.00001), also with no heterogeneity noted (Chi2 = 0.48; df = 2 [p = 0.79]; I2 = 0%). Finally, the combination of ADT with docetaxel showed a superior overall survival (OS) compared with ADT alone (HR = 0.73; 95% CI: 0.64 to 0.84; p<0.0001), with moderate heterogeneity (Chi2 = 3.84; df = 2 [p = 0.15]; I2 = 48%). A random-effects model analysis was performed, and the results remained favorable to the use of ADT plus docetaxel (HR = 0.73; 95% CI: 0.60 to 0.89; p = 0.002). In the final combined analysis of the high-volume disease patients, the use of the combination therapy also favored an increased overall survival (HR = 0.67; 95% CI: 0.54 to 0.83; p = 0.0003). Regarding adverse events and severe toxicity (grade ≥3), the group receiving the combined therapy had higher rates of neutropenia, febrile neutropenia and fatigue. CONCLUSION: The combination of ADT with docetaxel improved the clinical progression-free survival, bPFS and OS of patients with mHNPC. A superior OS was seen especially for patients with metastatic and high-volume disease. This contemporary combination therapy may now be offered as a first-line treatment for selected patients.

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The prevalence of urinary incontinence in the elderly varies from 8 to 34% according to the criteria or method of investigation. The etiology or main associated factors are: aging tissular degeneration that compromise the lower urinary tract and pelvic floor, changes of peripheric and central nervous system, hormonal alterations such as menopause, nocturnal polyuria, benign prostate hyperplasia, concomitant diseases and side effects of medical drugs. The incontinence may be transitory or permanent. Besides a criterious medical history for a better characterization of the urinary loss, a search for associated or concomitant causes and the miccional diary, one oftenly may rely on specialized exams such as urodynamics. A specific diagnosis is of utmost value for correct management that may require only conservative measures based on changes of behaviour or counceiling, drugs prescription, or invasive methods including surgical procedures.

A prevalência da incontinência urinária no idoso varia de 8 a 34% segundo o critério ou método de avaliação. A principais causas são: alterações teciduais da senilidade que comprometem o trato urinário inferior e o assoalho pélvico, do sistema nervoso central e periférico, alterações hormonais como a menopausa, poliúria noturna, alterações psicológicas, hiperplasia prostática benigna, doenças concomitantes e efeitos colaterais de medicamentos. A incontinência pode ser transitória ou permanente. Além da anamnese cuidadosa para caracterização das perdas urinárias, a busca de causas associadas ou concomitantes e o diário miccional, recorre-se com freqüência a exames especializados como a urodinâmica. O diagnóstico preciso é importante para o manejo adequado que pode requerer apenas medidas conservadoras baseadas em orientações e mudanças de hábitos, como o uso de medicamentos, ou então métodos invasivos que incluem procedimentos cirúrgicos específicos.

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Purpose: Urinary lithiasis is an uncommon complication in recipient of kidney allografts. The prevalence varies from 0.02 to 3.4%. The majority of calculi arises de novo in the recipient, however some of them are transferred with the transplanted kidney. The treatment relies on few reports published previously. The aim of the study is to determine the prevalence of lithiasis as well as the treatment in an university hospital. METHODS: We analyzed 953 recipients of renal transplant undertaken in Hospital das Clínicas - FMRP-USP, from February of 1968 to May of 2003. The mean age of patients bearing lithiasis was 47.2 years (range 35 to 63 years). RESULTS: The prevalence of lithiasis was 10/953 (1.0%). Nine patients received kidneys from cadaver donor and 1 from living donor. The diagnosis occurred during the surgery in 2 (20%), within few days after transplantation in 1 (10%) and in the late postoperative period in 7 (70%). Seven patients had no complains, 2 had associated urinary tract infection and 1 a rise in serum creatinine. Of 8 cases with lithiasis in the postoperative period, the stones were localized in the kidney in 6 and in the ureter in 2. Renal calculi were managed as follows: watchful-waiting - 2, extracorporeal lithotrypsy - 2, percutaneous nepholithotrypsy - 1 and open pyelolithomy - 1. One patient with ureteric lithiasis associated ureteral stenosis underwent a pyelo-vesicostomy. The other patient with ureteric lithiasis was treated by retrograde endoscopic ureterolithothrypsy. CONCLUSION: Urinary lithiasis is rare in transplanted kidneys and can be managed as to the general population.

OBJETIVO: A litíase urinária é uma complicação incomum no alotransplante renal, a incidência varia de 0,02 a 3,4%. A maioria dos cálculos forma-se após o transplante, porém alguns podem ser transferidos junto com o enxerto para o hospedeiro. O tratamento desta complicação está baseado em alguns casos descritos na literatura. O objetivo deste trabalho é o de relatar a incidência da litíase renal no paciente com transplante renal, assim como a conduta adotada no HCFMRPUSP. MÉTODOS: Foram analisados 953 pacientes submetidos a transplante renal no HCFMRPUSP, de fevereiro 1968 a maio de 2003. A idade média foi de 47,2 anos (35 a 63 anos). Em 09 pacientes, o rim foi proveniente de doador cadáver e apenas 01 doador vivo. RESULTADOS:Foram diagnosticados 10 casos de litíase (1,05%). Em 02 pacientes (20%) o cálculo foi diagnosticado no intraoperatório, em 01 (10%) no peri-operatório (5º. dia), os 07 restantes (70%) no pós-operatório tardio. Em 04 pacientes (57%) não havia sintomatologia específica, 02 (29%) apresentaram ITU, em 03 (43%) ocorreu elevação da creatinina sérica. De 8 pacientes com litíase no pós-operatorio, em 06 os cálculos estavam localizados no rim e 02 no ureter. Dos pacientes com cálculos renais, 02 foram observados, 02 submetidos a LECO, 01 a nefrolitripsia percutânea, 01 à pielolitotomia. Em 01 paciente com cálculo ureteral foi realizada pielovesicostomia (cálculo + estenose), no outro paciente foi feita a ureterorrenoscopia retrógrada. CONCLUSÃO: A urolitíase é complicação rara no transplante renal, a conduta terapêutica no pós-operatório tardio é semelhante à da população geral.

RESUMO

Purpose: Urinary lithiasis is an uncommon complication in recipient of kidney allografts. The prevalence varies from 0.02 to 3.4%. The majority of calculi arises de novo in the recipient, however some of them are transferred with the transplanted kidney. The treatment relies on few reports published previously. The aim of the study is to determine the prevalence of lithiasis as well as the treatment in an university hospital. METHODS: We analyzed 953 recipients of renal transplant undertaken in Hospital das Clínicas - FMRP-USP, from February of 1968 to May of 2003. The mean age of patients bearing lithiasis was 47.2 years (range 35 to 63 years). RESULTS: The prevalence of lithiasis was 10/953 (1.0%). Nine patients received kidneys from cadaver donor and 1 from living donor. The diagnosis occurred during the surgery in 2 (20%), within few days after transplantation in 1 (10%) and in the late postoperative period in 7 (70%). Seven patients had no complains, 2 had associated urinary tract infection and 1 a rise in serum creatinine. Of 8 cases with lithiasis in the postoperative period, the stones were localized in the kidney in 6 and in the ureter in 2. Renal calculi were managed as follows: watchful-waiting - 2, extracorporeal lithotrypsy - 2, percutaneous nepholithotrypsy - 1 and open pyelolithomy - 1. One patient with ureteric lithiasis associated ureteral stenosis underwent a pyelo-vesicostomy. The other patient with ureteric lithiasis was treated by retrograde endoscopic ureterolithothrypsy. CONCLUSION: Urinary lithiasis is rare in transplanted kidneys and can be managed as to the general population.

OBJETIVO: A litíase urinária é uma complicação incomum no alotransplante renal, a incidência varia de 0,02 a 3,4%. A maioria dos cálculos forma-se após o transplante, porém alguns podem ser transferidos junto com o enxerto para o hospedeiro. O tratamento desta complicação está baseado em alguns casos descritos na literatura. O objetivo deste trabalho é o de relatar a incidência da litíase renal no paciente com transplante renal, assim como a conduta adotada no HCFMRPUSP. MÉTODOS: Foram analisados 953 pacientes submetidos a transplante renal no HCFMRPUSP, de fevereiro 1968 a maio de 2003. A idade média foi de 47,2 anos (35 a 63 anos). Em 09 pacientes, o rim foi proveniente de doador cadáver e apenas 01 doador vivo. RESULTADOS:Foram diagnosticados 10 casos de litíase (1,05%). Em 02 pacientes (20%) o cálculo foi diagnosticado no intraoperatório, em 01 (10%) no peri-operatório (5º. dia), os 07 restantes (70%) no pós-operatório tardio. Em 04 pacientes (57%) não havia sintomatologia específica, 02 (29%) apresentaram ITU, em 03 (43%) ocorreu elevação da creatinina sérica. De 8 pacientes com litíase no pós-operatorio, em 06 os cálculos estavam localizados no rim e 02 no ureter. Dos pacientes com cálculos renais, 02 foram observados, 02 submetidos a LECO, 01 a nefrolitripsia percutânea, 01 à pielolitotomia. Em 01 paciente com cálculo ureteral foi realizada pielovesicostomia (cálculo + estenose), no outro paciente foi feita a ureterorrenoscopia retrógrada. CONCLUSÃO: A urolitíase é complicação rara no transplante renal, a conduta terapêutica no pós-operatório tardio é semelhante à da população geral.

RESUMO

The prevalence of urinary incontinence in the elderly varies from 8 to 34% according to the criteria or method of investigation. The etiology or main associated factors are: aging tissular degeneration that compromise the lower urinary tract and pelvic floor, changes of peripheric and central nervous system, hormonal alterations such as menopause, nocturnal polyuria, benign prostate hyperplasia, concomitant diseases and side effects of medical drugs. The incontinence may be transitory or permanent. Besides a criterious medical history for a better characterization of the urinary loss, a search for associated or concomitant causes and the miccional diary, one oftenly may rely on specialized exams such as urodynamics. A specific diagnosis is of utmost value for correct management that may require only conservative measures based on changes of behaviour or counceiling, drugs prescription, or invasive methods including surgical procedures.

A prevalência da incontinência urinária no idoso varia de 8 a 34% segundo o critério ou método de avaliação. A principais causas são: alterações teciduais da senilidade que comprometem o trato urinário inferior e o assoalho pélvico, do sistema nervoso central e periférico, alterações hormonais como a menopausa, poliúria noturna, alterações psicológicas, hiperplasia prostática benigna, doenças concomitantes e efeitos colaterais de medicamentos. A incontinência pode ser transitória ou permanente. Além da anamnese cuidadosa para caracterização das perdas urinárias, a busca de causas associadas ou concomitantes e o diário miccional, recorre-se com freqüência a exames especializados como a urodinâmica. O diagnóstico preciso é importante para o manejo adequado que pode requerer apenas medidas conservadoras baseadas em orientações e mudanças de hábitos, como o uso de medicamentos, ou então métodos invasivos que incluem procedimentos cirúrgicos específicos.

RESUMO

OBJECTIVE: The aim of the study was to investigate the influence of the prostate volume and PSA density on the performance of total PSA to diagnosis of prostate carcinoma. METHODS: We analyzed 217 patients (PSA 0-10ng/ml) submitted to transrectal sextant prostate biopsy. Criteria for biopsy indication was PSA >2ng/ml and/or digital rectal exam suspicious of prostate cancer. RESULTS: Fifty five patients had prostate neoplasia (25.3%) and in 8/55 (25.3%) the serum PSA was under 4ng/ml. The sensitivity and specificity of the test were respectively 98.2% / 16.6% at a cut-off point of 2.5ng/ml and 85.4% / 38.8% at cut-off of 4ng/ml. The corresponding values for prostates >40ml or 40ml were: 96.2% / 8.1% and 100% / 27.2% at the cut-off point of 2.5ng/ml, and 92.5% / 20% and 78.5% / 62.3% at a cut-off level of 4ng/ml. For prostates 40ml a PSA cut-off point of 4ng/ml leads to a misdiagnosis in 21.4% of the malignant tumors. The median PSAD of benign prostates are different according to prostate volume (.40ml or 40ml). PSAD at cut-off of 0.08 increases the PSA specificity at both PSA cut-off points. CONCLUSIONS: Prostate volume affects the sensitivity and specificity of PSA and the median values of PSAD. PSAD of 0.08 increases the PSA specificity specially at a cut-off point of 2.5ng/ml in prostates smaller than 40ml.

RESUMO

OBJECTIVE: The aim of the study was to investigate the influence of the prostate volume and PSA density on the performance of total PSA to diagnosis of prostate carcinoma. METHODS: We analyzed 217 patients (PSA 0-10ng/ml) submitted to transrectal sextant prostate biopsy. Criteria for biopsy indication was PSA >2ng/ml and/or digital rectal exam suspicious of prostate cancer. RESULTS: Fifty five patients had prostate neoplasia (25.3%) and in 8/55 (25.3%) the serum PSA was under 4ng/ml. The sensitivity and specificity of the test were respectively 98.2% / 16.6% at a cut-off point of 2.5ng/ml and 85.4% / 38.8% at cut-off of 4ng/ml. The corresponding values for prostates >40ml or 40ml were: 96.2% / 8.1% and 100% / 27.2% at the cut-off point of 2.5ng/ml, and 92.5% / 20% and 78.5% / 62.3% at a cut-off level of 4ng/ml. For prostates 40ml a PSA cut-off point of 4ng/ml leads to a misdiagnosis in 21.4% of the malignant tumors. The median PSAD of benign prostates are different according to prostate volume (.40ml or 40ml). PSAD at cut-off of 0.08 increases the PSA specificity at both PSA cut-off points. CONCLUSIONS: Prostate volume affects the sensitivity and specificity of PSA and the median values of PSAD. PSAD of 0.08 increases the PSA specificity specially at a cut-off point of 2.5ng/ml in prostates smaller than 40ml.